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Academy of Medical Royal Colleges
The Academy of Medical Royal Colleges was established in 1976 to coordinate the work of the medical royal colleges and faculties. For further information and for links to each of the medical royal colleges, please refer to the Academy of Medical Royal Colleges.

Accelerated medical degrees
In recent years, the General Medical Council (GMC has approved a number of accelerated medical degrees. These are usually offered to graduates with a first degree in a science subject. A list of these four year graduate entry programmes can be found in the BMA online guide Becoming a doctor.

Access courses
The main aim of access courses is to prepare adult learners from non-traditional backgrounds and under-represented groups for admission to undergraduate education. In the context of medicine, access courses also allow students with non-science backgrounds the opportunity to study science, which can provide a route into studying medicine. Students can study access courses, including sciences for medicine, at a number of further education (FE) colleges and adult education colleges. These courses normally last for one year. Some access courses to medicine offer a possible route to university entry by providing an intensive foundation in chemistry and biology. For more information on access courses refer to the University and Colleges Admissions Service (UCAS) or to Learn Direct (www.learndirect.co.uk).

For students with good, non-science grades at A level or equivalent, several universities offer the chance to study a foundation or pre-medical course. The nature of these courses varies from school to school but they sometimes form the first part of a six year medical degree. For a list of medical schools offering foundation or pre-medical courses, see the BMA’s online publication Becoming a doctor.

Access to medicine courses
'Access to medicine’ courses should not be confused with ‘access’, ‘foundation’ or ‘pre-medical courses’. Access to medicine courses are run by some medical schools to encourage wider access to medicine. This involves encouraging applications from students with non-traditional backgrounds. For example, Guy’s, King’s and St Thomas’ medical school runs a six year course for local disadvantaged students. This allows students to study at a slower pace and with more support for the first three years of the course. The selection procedure recruits students on the basis of their potential and suitability for medical training, rather than their actual or predicted performance at A level. Sheffield’s Outreach and Access to Medicine programme (SOAMs) provides places and financial support to pupils with an aptitude for medicine and no family history of higher education.

Appraisal
The aim of appraisal is to give doctors regular feedback on past performance and continuing progress and to identify education and development needs. More specifically, appraisal:

• sets out personal and professional development needs, career paths and goals – national appraisal documentation includes a personal development plan based on the needs of the individual and employer
• agrees plans for these needs to be met
• reviews the doctor’s performance
• considers the doctor’s contribution to the quality and improvement of local healthcare services.

It is the responsibility of Chief executives of NHS organisations to ensure that annual appraisal for consultants, GPs, clinical academics and staff grade doctors takes place and that appraisers are properly trained to carry out this role. The appraiser should have a good understanding of the work carried out by the doctor being appraised, including any specialist aspects of performance.

Appraisal is based on the General Medical Council (GMC)’s document Good Medical Practice (2006) which describes the principles of good medical practice. These are:

• good clinical care
• maintaining good medical practice
• teaching and training
• relationships with patients
• dealing with problems in professional practice
• working with colleagues
• probity
• health.

The GMC and Department of Health recommend that the appraisal process should embody a positive and developmental approach, be fair, effective and well-informed and, where possible, indicate how patient care and working within NHS organisations can be improved. Appraisal should include data on clinical performance, training and education, audit, concerns raised and serious clinical complaints, application of relevant clinical guidelines, relationships with patients and colleagues, teaching and research activities, and personal and organisational effectiveness.

Every doctor undergoing appraisal needs to prepare an appraisal folder demonstrating information, evidence and data to inform the process, which can be updated as necessary. The doctor and appraiser should agree a written overview of the appraisal, which should include a summary of achievement in the previous year, objectives for the next year, key elements of a personal development plan, actions expected of the organisation, a standard summary of the appraisal and a joint declaration that the appraisal has been carried out properly.

Appraisal forms part of a doctor’s career development. It will also a method for gathering evidence for the revalidation/re-licensing of doctors in order for them to continue practicing.

The BMA has an online resource on appraisal for GPs.

Assessment
Assessment is, of course, a very broad term. In the context of medicine it is often used professionally to describe the measurement of a student's progress.

There is often confusion between assessment and appraisal. These are two distinct processes with different aims. Assessments measure progress based on relevant curricula, while appraisals provide a complementary or parallel approach which focuses on the trainee and his or her professional needs [3]. Assessment involves the measurement of an individual’s performance at a particular point in time, usually against predetermined standards. Results of assessments can feed into appraisals if appropriate.

Medical student assessment has seen radical changes over the last twenty years, with a move from written based tests to those where competencies are measured. Traditional medical courses and assessments concentrated on factual knowledge. More recently assessment methods are being developed to assess other areas such as communication, clinical skills, attitudes, ethics and professionalism [4].

Many medical schools are developing ‘learning outcomes’ or ‘goals’ that they expect their graduates to achieve by the end of the course. These are sometimes called exit outcomes and may be expressed as ‘competencies’, ‘roles’, ‘outcomes’ or ‘goals’. Another common way of classifying the material that is assessed is by using the areas of ‘knowledge, skills and attitudes’ [4].

Some assessments, usually occurring at the end of a period of training, are designed to ensure that students have achieved the required standard and are competent to progress with the course. These are called summative assessments.

Other assessments do not act as a barrier to course progression but offer students feedback on their performance. These are often called formative assessments. Formative assessment can be formal or informal. It sometimes facilitates decisions on what educational interventions are required [5].

Some assessments are designed to fulfil the requirements of both summative and formative assessment.

Different types of assessment measure different aspects of being a doctor. In the context of medical education, assessment schedules should test the student in relation to curriculum outcomes using an appropriate range of assessment methods [6]. There are a number of different methods of assessment that are used to test the ability and performance of medical students and doctors.

There are several different types of written exams designed to test knowledge, and sometimes also the student’s ability to critically appraise information. They all assess knowledge of basic clinical science, patient investigation and management, health promotion, clinical reasoning and judgement:

Multiple choice questions (MCQs) provide a common form of written assessment. These may sometimes be negatively marked so students lose marks for incorrect answers.

Extended matched items (EMIs), designed to test knowledge and reasoning skills, resemble MCQs but offer more answers to chose from.
Short answer/key feature questions generally require a sentence or one or two word answers. Constructed response/semi-structures/ modified essay questions ask for a sequence of short answers about a given case. Essay questions can take many forms such as describing or comparing and contrasting medical conditions. Many written exams are now taken using computers [4]. Portfolios, log books and record of achievements may be used to assess progress throughout the course, with an emphasis on clinical skills. They may be designed to assess and develop a student’s ability to reflect on their own development and progression in the course [4].

In addition to written assessments, medical students will also encounter many forms of assessment designed to assess their practical skills:

• Spot/spotter exams or objective structured practical exams (OSPE) test students’ knowledge of anatomy, pathology and histological structures and their functions and clinical application. The assessment consists of different stations, each with a body part specimen, photo, x-ray or scan on which students answer questions [4].
• Long cases are exams designed to assess how students approach patients. They look at history taking, examination skills and clinical reasoning. A student may be asked to spend between 20 and 60 minutes with a patient before presenting the patient to the examiner and being asked questions about their findings.
• The OSLER is a structured version of the long case. A student may be questioned at the bedside before going into another room for an oral assessment or viva.
• Short cases require students to examine part of the patient, without taking a history, before reporting their findings. Despite not requiring a history to be taken, students may still be assessed on their communication skills [4]. An objective structured clinical exam (OSCE) is similar to spot assessment and involves a number of stations, each with a different task. Students are given a set time to complete each station, demonstrating a certain skill. OSCEs takes place under exam conditions in the presence of an observer who scores a check list [7]. Some medical schools may include ‘veto’ stations – for example on resuscitation and communication. If students fail these veto stations they will be expected to undergo further training, even if they pass the rest of the OSCE [4]. As well as being used in medical schools, OSCEs are used to test the English language skills of non-UK qualified doctors.

Oral/vivas/viva voce exams can be used for a number of assessment purposes. This type of assessment often helps candidates who do not perform well in written papers. Orals may form part of OSCE exams [4].

Association for Medical Education in Europe (AMEE)
The Association for Medical Education in Europe (AMEE) is a worldwide association for all those interested in medical and healthcare professionals’ education. It is concerned with the continuum of education from undergraduate through to postgraduate education and facilitates research into medical education. Please refer to the AMEE website for further information on its key aims.

Association for the Study of Medical Education (ASME)
The Association for the Study of Medical Education (ASME) is a membership organisation for doctors and medical educators from any speciality. It functions as a forum for debate and exchange of information, to promote knowledge and expertise in medical education. Further information can be obtained from ASME.

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